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Why Can’t I Sleep or Get Pregnant?


a blog by Breea Johnson, MS, RD, LDN Pulling Down the Moon, July 28, 2010

After seeing many women with infertility at Pulling Down the Moon for nutrition counseling, it’s easy to start seeing a lot of common trends among my clients. One that I see quite frequently is insomnia, or having difficulty going to sleep and staying asleep. While stress, worry and an over-thinking mind can definitely make it difficult to sleep, there are many other more biochemical and physiological reasons that women can’t get some Zs. A few to consider are an elevated cortisol level, caffeine intake, poor diet and lack of exercise.

The Sleep Process

Let’s take a brief look at the process of sleep. For the lucky woman, when she begins to go to sleep her metabolism decreases and her heart rate slows. Her muscles relax, and her breathing becomes more regular. Some thoughts of the day may run through her mind, but within 15 to 30 minutes, lights are out and she is fast asleep.

Enter insomnia — a persistent difficulty falling and staying asleep. So what differs between the woman who can get an easy eight hours per night and the woman who can’t fall asleep (without medication) and when does, she wakes up every few hours tossing and turning?

Let’s discuss cortisol, the “anti-sleep hormone.” Cortisol is a hormone secreted from the adrenal cortex (the adrenal glands sit on top of the kidneys and are in charge of releasing hormones such as cortisol, androgens, estrogen, progesterone, DHEA, ephinephrine, and norepinephrine also called adrenaline). Cortisol is typically released in the morning when blood glucose (sugar) drops. You open your eyes, get ready for the morning and feel hungry, so you eat breakfast. As the day goes on, your cortisol levels naturally decrease, and by 9 or 10 p.m. you are relaxed and ready to jump into bed and soon are fast asleep. And the cycle continues.

Too Much Cortisol

So, how does this cycle get out of whack?

The number one contributor is stress. Cortisol is triggered in stressful situations, so having constant stress can keep cortisol unnaturally elevated and contribute to insomnia. Another factor in altered cortisol levels is caffeine. Caffeine raises cortisol levels. So, while having one cup of Joe in the morning when your cortisol levels are already high may be okay, having a cup of coffee in the afternoon or evening can lead you to a restless night’s sleep. Having multiple cups of coffee (or any of the caffeinated beverage varieties) can continually trigger a cortisol response, which after a while can lead to adrenal fatigue or exhaustion.

Does your energy crash in the afternoon? Having blood sugar swings can also lead to altered cortisol levels because a high intake of carbohydrates (especially the processed ones) can lead to increased levels of insulin and cortisol, furthering your body’s natural sleep cycle out of sync. There are also specific nutrients that are beneficial for cortisol production and degradation. Magnesium, for one, helps to decrease cortisol levels and also helps to relax smooth muscles.

The Link to Fertility

What does this have to do with fertility? When the adrenal glands are over-worked from high stress and poor diet, hormones can easily become imbalanced. High levels of cortisol production can lead to low levels of other hormone production such as estrogen, progresterone, testosterone and DHEA. DHEA, which is inversely related to cortisol production, is an important steroid hormone that has been found to be beneficial for Decreased Ovarian Reserve (DOR). Additionally, high insulin levels can interfere with ovarian hormones, further complicating the process of reproduction. So, helping with insomnia may also benefit fertility.

If you struggle with insomnia and infertility, try these tips:

    1. Have a plan to manage stress. Beyond watching TV and shopping, doing something daily to manage stress is pivotal in our society. Yoga, gardening, deep breathing, meditation, weekly massages, acupuncture, walking, bike riding, cooking, cleaning — whatever makes you feel happy and stress-free.

    2. Make a rule not to eat anything with caffeine after 11 a.m. That includes coffee; black, green or white tea; iced tea; chocolate;energy drinks and soda. If you can, eliminate caffeine altogether.

    3. Make time to sleep. Many people do not give themselves adequate time to sleep — pushing themselves to the brink of exhaustion. While you might not be sleeping for eight hours, give yourself at least eight hours to have time to sleep, and try jumping into an already made bed.

    4. Exercise early. Consistent exercise helps reduce stress but exercise can actual increase cortisol levels, which if done after work may interfere with your ability to sleep. Try exercising before work or on your lunch break. Or, try a lower impact exercise like yoga in the evening.

    5. Manage blood sugar. Eating regularly and making sure to get protein and healthy fats at every meal can be extremely beneficial for adrenal health, and lead to easier sleeping.

    6. Eat lots of green leafy vegetables. These vital veggies are high in magnesium and help with muscle relaxation. Try kale, collard greens, spinach and Swiss Chard.

    7. If you can’t sleep, try taking a Magnesium supplement (with at least 100 mg of magnesium) or take an Epsom Salt bath before retiring to bed. Epsom salts are made of magnesium and help muscle relaxation. PDtM carries MyoCalm, a magnesium-based supplement with herbs to help relaxation prior to sleeping.

For more information on insomnia, infertility and adrenal health, please contact Pulling Down the Moon to make an appointment with one of our Fertility Nutrition Specialists.

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